Nasal Airway in Breathing and Speech

Abstract

Clefts of the lip and palate frequently produce nasal deformities that tend to reduce the size of the nasal airway. Approximately 70% of the cleft population have nasal airway impairment and about 80% “mouth-breathe” to some extent. Surgical correction of nasal, palatal, and pharyngeal structures may further compromise breathing. Type of cleft appears to affect airway size, with unilateral clefts demonstrating the smallest airway. Although a pharyngeal flap may further decrease airway size, some individuals do not notice a postoperative change because of airway compromise prior to flap placement. Speech is a modified breathing behavior that uses the respiratory system to provide an energy source and involves structures within the respiratory tract to modulate this energy into meaningful sounds. The oral, nasal, and pharyngeal structures that are affected by cleft lip and palate during breathing are often compromised for speech as well. The nasal airway plays an important role in controlling speech pressures when velopharyngeal function is impaired. A “good” nose for breathing is often a “bad” nose for speech under such circumstances.

Nasal Airway Dimensions of Children with Repaired Unilateral Cleft Lip and Palate

“…Sleep disordered breathing may also arise, which comprises a wide spectrum of abnormalities; those related to increased upper airway resistance include snoring, upper airway resistance syndrome, and obstructive sleep apnea-hypopnea syndrome (American Academy of Sleep Medicine, 2005). In children with repaired cleft lip and palate, the obstructive conditions may persist until rhinoseptoplasty is performed or even later (Warren et al, 1992;Warren and Drake, 1993;Trindade et al, 2009;Shadfar et al, 2012;Mor´en et al, 2013).…”

Dental arches in submucous cleft palate: Comparison of six-year-old boys with unoperated submucous cleft palate, with operated cleft of the soft palate, and without a cleft

“…Wider maxillary dental arches have been reported in 8-yearold children with CP after abandonment of pushback repair [7] and in 5-year-old children with CP operated on by the newer minimal incision techniques described by Mendoza, when compared to those operated on using the Veau-Wardill-Killner technique [15]. Furthermore, impairment of the nasal airway [27], early feeding difficulties, and recurrent infections are typical of children with isolated CP. Mouth-breathing in children causes a reduction in the size of both maxillary and mandibular arch widths [28,29].…”

Three-dimensional Evaluation of Mandibular Volume in Patients with Cleft Lip and Palate During the Deciduous Dentition Period

“…1,2 Patients born with these congenital malformations often require surgical intervention to correct problems associated with malocclusion, speech and respiratory difficulties, esthetics and psychosocial concerns. 3,4 Patients with CLP usually have a flattened cranial base, midface deficiency with a retruded maxilla and elongated mandible, anterior and/or posterior crossbites, and increased vertical dimension. 5 Yet there is some anatomical variation among patients with different types of cleft palate deformities such as unilateral cleft lip and alveolus (UCLA), unilateral cleft lip and palate (UCLP), and bilateral cleft lip and palate (BCLP).…”